AB0584 MANAGEMENT OF REFERRALS, TREATMENT STRATEGY, AND RESEARCH CHALLENGES IN POLYMYALGIA RHEUMATICA AMONGST RHEUMATOLOGISTS WORLDWIDE: A QUESTIONNAIRE BASED STUDY
Authors: A. Overgaard Donskov, S. Mackie, E. M. Hauge, C. Toro Gutiérrez, I. Hansen, A. Hemmig, A. Van der Maas, T. A. Gheita, B. Dalsgaard Nielsen, K. Douglas, R. Conway, E. Rezus, B. Dasgupta, S. Monti, E. Matteson, S. E. Sattui, M. Matza, V. Ocampo, A. Bran, S. Appenzeller, A. Goecke, N. Colman MC Leod, H. Keen, M. Kuwana, L. Gupta, B. Salim, G. Harifi, M. Erraoui, N. Ziade, N. A. Al-Ani, A. Ajibade, J. Knitza, L. Frølund, M. Yates, V. Pimentel-Quiroz, A. Lyrio, M. Sandovici, K. Van der Geest, T. Helliwell, E. Brouwer, C. Dejaco, K. Keller
Journal: Annals of the Rheumatic Diseases (2022)

Background Polymyalgia rheumatica (PMR) is diagnosed and treated by both general practitioners (GP) and rheumatologists. How rheumatologists around the world manage the referral process of patients with PMR from GP’s has not been described. EULAR/ACR guidelines recommend initial prednisolone doses between 12.5 and 25 mg, but it is unknown if guidelines are followed in daily clinical practice 1 . In addition, the understanding of challenges for recruitment to clinical trials in PMR is currently limited. Objectives This study aims to describe the management of referrals, treatment strategy, and recruitment to clinical trials in PMR among rheumatologists worldwide. Methods An English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. Questions concerned: 1: respondent, 2: referrals, 3: prednisolone, and 4: barriers to research. Questionnaires were distributed to rheumatologists via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 2 nd of November 2021 to 27 th of January 2022. Countries were grouped by income and geographical region based on the World bank classifications. Data were weighted by number of inhabitants in a country, based on the United Nations age specific population count, divided by number of respondents in a country. Countries with more than 20 respondents were included. Results Results from 27 countries were analysed including 1000 responders in total (Figure 1). There was large variation in time from referral to first assessment, initial dose of prednisolone was high, duration of treatment was relatively short, and a large proportion of patients with newly diagnosed PMR received prednisolone prior to rheumatological evaluation (Table 1). Concerning the 15% of respondents who performed research in PMR, 52% had participated in clinical trials and 56% of the responders experienced difficulties with recruitment. Table 1. Characteristics of reponders, referrals, and treatment. Geographical region Income The world Europe and Central Asia North America Latin America East Asia and Pacific South Asia Middle East and Africa High- income countries Low- and middle- income countries Responders Responders (n), Completed questionnaire (total) 875 (1000) 294 (304) 78 (81) 136 (152) 53 (53) 53 (72) 261 (338) 446 (458) 429 (542) Experience as rheumatologist (years) 11 (6-20) 12 (6-20) 7 (4-20) 11 (6-23) 21 (10-30) 7 (4-10) 9 (5-18) 11 (5-22) 8 (5-12) Referrals GP’s can discuss patients prior to referral, % 64 79 79 57 58 60 67 74 61 Referred patients seen (%) 100 (90-100) 100 (90-100) 100 (100-100) 100 (100-100) 100 (95-100) 100 (100-100) 100 (60-100) 100 (100-100) 100 (90-100) Evaluation &gt; 2 weeks after referral, % 26 49 80 60 21 6 18 58 15 Prednisolone Started prior to rheumatological evaluation (%) 50 (20-50) 60 (30-80) 70 (50-80) 50 (10-50) 30 (20-50) 50 (20-80) 20 (0-50) 50 (30-80) 50 (10-70) Initial dose (mg) 20 (15-40) 20 (15-20) 20 (15-20) 20 (20-40) 15 (15-15) 20 (15-40) 20 (15-40) 15 (15-20) 20 (15-40) Initial dose &gt; 25 mg, % 32 9 6 41 0 41 43 6 42 Duration of treatment (months) 12 (6-12) 12 (12-18) 12 (10-18) 6 (3-12) 18 (12-18) 12 (6-12) 6 (3-12) 12 (12-18) 9 (6-12) Data presented as weighted median (interquartile range) unless otherwise stated. GP: general practitioner Conclusion This is the first description of current practice in managing referrals and treatment of PMR by rheumatologists worldwide. In general, median treatment duration was according to EULAR/ACR guidelines, but initial dose of prednisolone was often higher than recommended in many parts of the world. PMR patients were often seen more than two weeks after referral, and treatment had started prior to first rheumatological evaluation. References [1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74 (10): 1799-807. Acknowledgements This study was endorsed by the international PMR/GCA study group. Disclosure of Interests Agnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis, Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Ib Hansen: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Tamer A Gheita: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Karen Douglas: None declared, Richard Conway Speakers bureau: Janssen, Roche, Sanofi, Abbvie,, Elena Rezus: None declared, Bhaskar Dasgupta: None declared, Sara Monti: None declared, Eric Matteson Consultant of: Boehringer-Ingelheim,, Grant/research support from: Boehringer Ingelheim,, Sebastian E. Sattui Grant/research support from: AstraZeneca, Mark Matza: None declared, Vanessa Ocampo Speakers bureau: Abbvie, Andrea Bran: None declared, Simone Appenzeller Grant/research support from: GSK, Annelise Goecke Speakers bureau: Abbvie, Boehringer Ingelheim, Recalcine. Consultant Abbvie, Boehringer Ingelheim, NELLY COLMAN MC LEOD Speakers bureau: Laboratorios FAPASA (Farmacéutica Paraguay), Helen Keen Speakers bureau: Roche, Abbvie, Masataka Kuwana: None declared, Latika Gupta: None declared, Babur Salim: None declared, Ghita Harifi Speakers bureau: Abvie, Johnson and johnson, Lilly, Novartis, Mariama Erraoui: None declared, Nelly Ziade Speakers bureau: Abbvie, Eli Lilly, Janssen, Pfizer, Pierre Fabre, Roche, Novartis, Sanofi-Aventis, Paid instructor for: Abbvie, Eli Lilly, Sanofi-Aventis, Pfizer, Janssen, Novartis., Consultant of: Abbvie, Eli Lilly, Janssen, Pfizer, Roche, Novartis, Sandoz, Grant/research support from: Abbvie, Celgene - Algorithm, Bristol-Myers Squibb - NewBridge, Pfizer, Nizar Abdulateef Al-Ani: None declared, Adeola Ajibade: None declared, Johannes Knitza: None declared, Line Frølund: None declared, Max Yates: None declared, Victor Pimentel-Quiroz: None declared, Andre Lyrio: None declared, Maria Sandovici: None declared, Kornelis van der Geest Speakers bureau: Roche, Toby Helliwell Grant/research support from: Valneva, Elisabeth Brouwer Speakers bureau: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared